Challenges associated with providing simulation-based medical education

Computer-based instructional programs in medicine, especially those that make use of graphics and simulation technology, are discussed. A number of impediments to this mode of teaching medical students are discussed, including: (1) the lack of knowledge about the learning process; (2) nonadaptive tutorial strategies; (3) difficulties associated with assessing simulation validity; (4) questionable transferability; (5) the lack of intuitive user interfaces; (6) the high cost of developing quality educational software; (7) the inability to customize applications to suit local teaching practices; (8) the high cost of computer hardware; and (9) ineffective evaluation methodologies